A Spokane Regional Health District program helps hundreds of women in Eastern Washington who qualify for free screenings to detect whether they have breast, cervical, or colon cancer.

The district has overseen what’s now called the Breast, Cervical and Colon Health Program (BCCHP) since 1999. Regular screening and early detection often mean treatment is more effective and less costly.

“The program is basically a cancer-screening program for these particular three cancers,” says program manager Donna Oliver. “If you can catch these cancers either in an early state or a precancerous state, it’s much easier to treat, much cheaper to treat, and of course, it saves lives.”

In the past five years, the program has assisted nearly 4,200 women to access free screenings, and the service helped 175 women get follow-up treatment for breast cancer and 36 women for cervical cancer.

However, Oliver says more people likely would benefit but aren’t aware support exists or they assume they wouldn’t qualify. The district refers people who do qualify under income and age guidelines to health care providers for screening services paid for by the program, Oliver says.

A program coordinator also tracks individuals’ progress to ensure provider access and support, such as transportation assistance, translators, or follow-up care in some cases.

“The way we administer the program is we contract with many different medical providers to actually do the services,” Oliver says. “We are contracted with primary-care clinics, hospitals, labs, specialists, radiology facilities, all the hospitals, and a few others.”

In outlying areas, she says, that involves many small clinics. However, in order for women to have mammograms or follow-up diagnostic work, some people in the outlying areas have to travel to Spokane.

Contracted providers agree to take BCCHP payments based on a negotiated lower fee schedule, Oliver says. BCCHP helps people in nine Eastern Washington counties, including Spokane, Ferry, Stevens, Pend Oreille, Lincoln, Adams, Garfield, Whitman, and Asotin. 

In addition to income and insurance status, program eligibility requires state residency and includes age criteria. The ages are based on screening recommendations and funding priorities. For example, cancer risk increases with age, and many people are eligible for Medicare at age 65.

For breast and cervical screening, the age range is 40 to 64 years old. Program-supported colon screening for both women and men is geared toward people ages 50 to 64. 

However, BCCHP also receives grants from Susan G. Komen Eastern Washington that enable it to help symptomatic women under age 40 with the breast cancer portion of its services. Also, men ages 19 to 64 with suspicious symptoms may be eligible for breast tests.

“The program helps people who might otherwise not be able to receive these screenings,” Oliver says. “Most are low income, defined as below 250 percent of the federal poverty level, so that would be for a family of four a gross monthly income of $5,063.”

While the Affordable Care Act has reduced program requests because more are insured under the state’s expanded Medicaid program, called Apple Health, plenty of need still exists, Oliver says. BCCHP helps people who either are still uninsured or what she describes as “underinsured,” meaning they have health insurance but are required to pay high deductibles and out-of-pocket expenses.

“Before the Affordable Care Act, most people coming our way didn’t have any insurance, and they were way below the 250 percent poverty level,” she says. Today, with Apple Health, anyone who is income-eligible to get Medicaid coverage doesn’t qualify for the program, she adds. 

Before the ACA, also called Obamacare, the SRHD program served about 2,000 clients a year and couldn’t keep up with demand, Oliver says. Since the ACA was implemented, only about 350 people a year receive program support, but the district likely could help many more, she says. 

“It’s shifted now,” Oliver adds. “We serve more people who are between 138 percent and 250 percent of poverty level, so they might be underinsured, have high out-of-pocket expenses, or not have any insurance because they couldn’t afford insurance. There’s still a significant need, and I think there’s been some confusion. People don’t necessarily know we’re here.” 

Oliver gives another example that perhaps insurance covers a mammogram 100 percent, but the test indicates a potential concern requiring follow-up diagnostic tests at patient cost until a deductible is met. 

“We’re hearing about $5,000 to $10,000 deductibles for some people,” she says. “Even if a deductible is lower, it might not be something they can afford.”

Those eligible can receive support for an office visit, mammogram, pap test, and physical exam. If further diagnostic tests are needed, the program covers costs up to a biopsy for those eligible. If breast or cervical cancer is detected, and the person doesn’t have insurance or meets requirements and can’t afford out-of-pocket expenses for follow-up care, the program also can assist with payments beyond screening support, Oliver says. 

For colon cancer prevention, a component added later, the program only provides screening cost support that doesn’t extend toward cancer treatment, she says. The screening it supports can include covering the cost of a take-home test or a colonoscopy.

Odessa resident Victoria Iverson, 42, heard about BCCHP after her August 2015 breast cancer diagnosis. She qualified after a struggle to pay high medical costs to meet her insurance deductible.

“I think my deductible was about $6,000 out-of-pocket,” Iverson says. “Because of the program, I didn’t have to pay anything out of pocket this year (2016). I am still paying on some of the bills I incurred before becoming eligible.”

With program support, she didn’t have to pay for chemo treatments, mastectomy surgeries in Spokane, and an unexpected hospital stay because of a surgery complication.

“The program has been extremely helpful,” she adds. “I can also pay my bills without worrying about all these medical expenses creeping up.”

Support for early-detection breast and cervical cancer screening stems from federal action in 1990, Oliver says. States adopted support programs, and later colon cancer screening was added. 

The Centers for Disease Control and Prevention provides a majority of BCCHP funding, along with some state dollars. Funding is provided through the state Department of Health, which contracts with entities statewide to handle support. In 2000, state lawmakers passed legislation that expanded support for breast and cervical cancer treatment, Oliver says. 

“What it allows us to do is transition any of our clients who have gone through our program and been diagnosed with breast or cervical cancer, that they can transition directly onto Medicaid to pay for their treatment,” she says. “We are obligated to take them all the way through to make sure they have an answer, and for women who are diagnosed, that they have access and a way to pay for treatment.” 

Oliver adds, “Those folks are people who wouldn’t otherwise be eligible for Medicaid. We follow them to make sure they’re getting treatment, and that they have Medicaid as long as they’re in active treatment.” 

That provision is only for people with diagnosed breast or cervical cancer, so it doesn’t apply to colon cancer treatment, she says. 

In Spokane, two employees support BCCHP, including Oliver as part-time manager. One full-time employee handles eligibility, client needs, data input, and billing. The health district mainly works with people over the phone and mails forms. People aren’t required to come into the office. 

“If clients need us, it’s best to call at (509) 324-1553,” Oliver says. “People may call us directly, or they may go through one of these providers. It’s a very simple process.”

Washington drivers can purchase a specialized breast cancer vehicle license plate, and proceeds will pay for mammograms and follow-up testing for eligible people through BCCHP.